从洋洋 邱晓 高天昊 黄崧华 赵娟 白玉龙

摘 要 对1例右肩袖损伤术后并发复杂性区域疼痛综合征（complex regional pain syndrome， CRPS）患者，采用以上肢运动疗法为主的综合康复治疗方法（包括关节松动、肌力训练、镜像疗法和手法淋巴引流等）治疗8个月，结果患者的症状和功能均获显著改善：疼痛的视觉模拟量表评分由7分降至0分；右手背轻触觉、两点辨别觉由障碍恢复至正常；右侧手指周径由较健侧手指粗0.5 ～ 0.7 mm降至粗0.1 ～ 0.2 mm；右侧肩、肘、腕、手的徒手肌力试验评级由3、4、3、3级提高到5、5、5、5级；右侧肩部、手部活动的受限程度得到较大改善；Barthel指数评分由80分提高到100分；CRPS严重程度量表评分由12分降至1分。综合康复治疗对肩袖损伤术后并发CRPS患者的效果较好，患者已回归正常的家庭生活。

关键词 肩袖损伤 复杂性区域疼痛综合征 物理疗法

中图分类号：R745； R493 文献标志码：B 文章编号：1006-1533（2021）09-0003-03

*基金项目：①上海市宝山区科学技术委员会科技创新专项资金项目（17-E-31）；②上海市卫生健康委员会科研课题（20204Y0442）

Rehabilitation of complex regional pain syndrome after arthroscopic rotator cuff repair： case report*

CONG Yangyang1， QIU Xiao1， GAO Tianhao1， HUANG Songhua1， ZHAO Juan1， BAI Yulong1， 2**（1. Department of Rehabilitation， Northern Division of Huashan Hospital， Fudan University， Shanghai 201907， China； 2. Department of Rehabilitation， Huashan Hospital， Fudan University， Shanghai 200040， China）

ABSTRACT A patient with complex regional pain syndrome （CRPS） after rotator cuff repair was treated with comprehensive rehabilitation training based on the upper limb movement therapy including joint loosening， muscle training， mirror therapy， technique lymph abstinence and so on for 8 months. As a result， the patients symptoms and function were significantly improved， in which the scores of Visual Analogue Scale were reduced from 7 to 0， the sense of light touch and the discrimination of two points on the back of right hand were returned from obstacles to normal， the circumference of the right finger was decreased from 0.5-0.7 mm to 0.1-0.2 mm compared with that of the healthy finger. The scores of manual muscle testing of right shoulder， elbow， wrist and hand were increased from 3， 4， 3， 3 to 5， 5， 5， 5， respectively， and the degree of restriction of the right shoulder and hand movement was greatly improved. Barthel index scores were increased from 80 to 100 and the CRPS Severity Scale scores were decreased from 12 to 1. Comprehensive rehabilitation treatment has a good effect on the patient with CRPS after rotator cuff injury， and the patient has returned to a normal family life.

KEy WORDS rotator cuff injury； complex regional pain syndrome； physical therapy

復杂性区域疼痛综合征（complex regional pain syndrome， CRPS）是指继发于创伤或全身性疾病后的一种以顽固性和多变性的严重疼痛、营养不良、功能障碍为特征的临床综合征[1]，其病因和发病机制还不十分明确[2-3]，诊断标准虽经不断修订，但现诊断仍主要依据患者的临床症状和体征[4]，治疗方法多种多样，至今尚无统一的标准治疗方法[5]。

肩袖是指肱骨头周围的一组肌腱复合体，对维持肩关节的稳定和活动有重要作用[6]。肩峰下撞击综合征是肩痛患者的最常见病因，占比达36%[7]。……